The flu is wreaking havoc globally this year. Influenza infections are on the rise, with the Centers for Disease Control and Prevention predicting that this year’s strain will cause the highest rate of hospitalizations and deaths in a decade.

This year also marks the 100th anniversary of the 1918 influenza pandemic. This pandemic was the worst flu outbreak in history, killing tens of millions of people around the world.

As an expert in public health law, I can state two things with confidence. First, the U.S. has made enormous strides in preparing for and treating the flu. And second, we still are not nearly as prepared as we need to be for the next pandemic.

A global scourge

The 1918 influenza strain was unusually deadly because humans had not been exposed widely to the H1N1 strain of the virus. It overwhelmed our naive immune systems. What’s more, influenza vaccines and other modern medical treatments had not yet been developed and infection control strategies were poorly understood. The spread of the disease was also fueled by troop movements connected with World War I.

Since 1918, flu outbreaks have fluctuated in size, but overall become less severe. Scientific advances have made influenza more preventable and treatable. Public health officials now know better how to contain influenza outbreaks and minimize their harm.

Nevertheless, the flu remains a persistent global scourge. Each year, the disease kills an estimated 12,000 to 56,000 people in the U.S. and 291,000 to 646,000 people worldwide. The influenza virus mutates rapidly and infects other animals in addition to humans, which allows new viral combinations to emerge and challenge our immune systems.

If the world were to face a new strain of flu similar in novelty and virulence to the 1918 virus, our capacity to prevent a pandemic would still fall short because we have not made sufficient progress in science, infrastructure or implementation of preparedness plans.